OEF 21B

I was successful on my first attempt at claiming OSA secondary to my PTSD. Like you, I had my pulmonologist state that my OSA aggravated my PTSD and my PTSD aggravated my OSA. The only difference that I can see is that I had my sleep study done through the VA at a civilian hospital to verify my OSA. I would recommend going to the VA requested Sleep Study and letting your appeal play out. Hopefully you'll be successful at the BVA!

Q1 - I am trying to get a general idea how long it is generally takes to be scheduled a DRO Hearing date for a NOD claim. My hearing happens to be in Waco. I filed my NOD in Nov 2012 and requested a DRO. My case was sent to Jansville even though I'm within the WACO VARO area. I Received the SOC 9 Apr 2015.... ...so about 29 months from filing the NOD to receiving the SOC. Semper Fi

Hi Wayne - We probably go to the same VAMC! I've been to the Dallas VAMC sleep clinic twice and all they do is check how many nights you've used your CPAP (I think she just plugged a wire into the machine and didn't even use an SD-Card). She asked a couple of questions about how I'm sleeping and do I feel drowsy while driving, after eating, ect., then asked if I had any questions, or if I needed any thing else. I told her that I needed a new face mask since mine was a year old. She put the order in and I just went downstairs and picked up a new face mask and hose. I wouldn't worry about "losing" your rating... the important thing is to keep using your CPAP! Semper Fi

Thanks Gastone. I assumed that it would take anywhere between 1-3 years to receive the BVA decision, then another 2-5 years if anything is sent back to the VARO on remand. You've gotta love the VA!! Semper Fi

Just wanted to check and see if this was the average time from initial claim to the BVA video hearing: AUG 30, 2010 - Initial Claim (VSO-DAV) NOV 13, 2012 - Award & denial(s) NOV 18, 2012 - Requested DeNovo DRO Review APR 9, 2015 - SOC (Granted one, denied the remaining) APR 12, 2015 - Form 9, Requested BVA Video Hearing OCT 17, 2016 - Video Hearing Scheduled Semper Fi

Here is what I put on my VA FORM 21-4138 when I filed my Sleep Apnea claim on 27 JUL 2015: I am claiming Sleep Apnea as a service connected condition secondary to my service connected PTSD (30 AUG 2010, 50% Rating). I submit for considerations three studies conducted at Brook Army Medical Center, Walter Reed Medical Center, and a report from the American Academy of Sleep Medicine that all not increased rates of Sleep Apnea in veterans with PTSD. VA Training letter 10-01 clearly states that SLEEP DISTURBANCES are included in Signs and Symptoms as Qualifying Chronic Disabilities for claims based on service in the Gulf War and Southwest Asia. My civilian physician, Dr. David H. Plump, examined me on 17 JUL 2015 and concluded that my OSA is at least as likely as not AGGRAVATED by my service connected PTSD and that it is at least as likely as not that my service connected PTSD is AGGRAVATED by my diagnosed OSA. Time-Line: Initial Claim: 27 Jul 2015 C&P by VES: 25 Aug 2015 Decision: 15 Jan 2016 Here is what my decision letter stated: - Service connection for sleep apnea has been established as related to the service-connected disability of posttraumatic stress disorder. - A higher evaluation of 100 is not warranted for sleep apnea syndromes unless the evidence shows: Carbon dioxide retention; or Chronic respiratory failure; or, Corpulmonale;,, or Tracheostomy required. - We have assigned a 50 percent evaluation for your sleep apnea based on: *Requires use of breathing assistance device such as a continuous airway pressure (CPAP) machine. I think that by claiming AGGRAVATION and not CAUSED BY PTSD, MDD, Chronic Pain, etc., is easier to get a non-VA doctor to write a nexus. Semper Fi -

Hi Jake, My C&P examiner rated me with "Anxiety Disorder, Not Otherwise Specified" even though my VA Psychiatrist diagnosed me with Combat Related PTSD. I filed a notice of disagreement and asked that the rating of Anxiety Disorder, NOS, be changed to Combat Related PTSD based on my VA diagnosis of Combat PTSD and on my VA treatment notes. I was granted the diagnosis of Combat Related PTSD based on my treatment notes and diagnosis. The only reason I wanted it changed was I'd been seeing several articles that were noting higher rates of heart issues in veterans with PTSD, and I thought that if I died of a heart related issue, that it could possibly be linked to my PTSD, which would service connect my death and provide additional benefits to my wife and kids. Are you in any PTSD programs at your VA? Have you had a VA Psych diagnose you? If so, and if you are within 1-year of your rating, I'd just file a NOD and provide the VA diagnosis and your treatment records and request a change in the named rating. Semper Fi -

Hi Wjason777 - here is what my decision letter said regarding my request for an increase: - The overall evidentiary record shows that the severity of your disability most closely approximates the criteria for a 70 percent disability evaluation. - We have assigned a 70 percent evaluation for your posttraumatic stress disorder based on: *Difficulty in adapting to stressful circumstances *Difficulty in adapting to work *Inability to establish and maintain effective relationships *Suspiciousness *Depressed mood *Disturbances of motivation and mood *Difficulty in adapting to a worklike setting *Anxiety *Difficulty in establishing and maintaining effective work and social relationships *Chronic sleep impairment. - A higher evaluation of 100 percent is not warranted for posttraumatic stress disorder unless the evidence shows total occupational and social impairment, due to such symptoms as: *grossly inappropriate behavior *persistent danger of hurting self or others *intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene) *disorientation to time or place *memory loss for names of close relatives, own occupation, or own name. My take on this was that I provided good evidence based on my VA treatment notes, increased meds, and validation by the QTC psychiatrist during my C&P. Good luck with your request! Semper Fi -

You need to have a talk with your HR department about "Reasonable Accommodations". It's illegal for an employer to discriminate against you, or belittle you because of a disability. In fact, and ESPECIALLY for the Federal Government, they have to accommodate your PTSD and aren't allowed to "share" your disability with anyone else. I work for the Fed. Govt. and am rated at 70% for PTSD. I met with our HR department and our EEO office and my supervisor and I worked out a reasonable accommodation program together. Best of luck to you as you continue to heal!!! Semper Fi -

Hi wablackwell, Most VA docs that care for patients won't fill out a DBQ. You will still need a diagnosis of PTSD from a VA psychiatrist or VA psychologist. You should be able to down-load all of your VA treatment notes from the E-Benefits Big Blue Button. Good luck with your claim!!

If your doc has had past success with his wording, then I'd just wait and see what happens... I think you have a very good package and hopefully you are service connected on the first go-round!

Hi Armyvet89! Is there any way that you can get your doctor to re-word the Nexus letter to include this statement: "It is my opinion that it is at least as likely as not that Armyvet89's diagnosed OSA is aggravated by his service-connected PTSD. I also feel that it is at least as likely as not that Armyvet89's PTSD is aggravated by his OSA." I also had my doc add this statement to SECTION VII - REMARKS on the DBQ form. I made sure that I stated in my SUPPORT IN STATEMENT OF CLAIM that I had no sleep issues noted in my service treatment records and did not have any sleep issues prior to my deployment. You're wife's letter should help as well. Good Luck with your claim! Semper Fi -

Hi Buck52 - I think my co-payment was $20 bucks. I have health insurance from my work to cover my family, and I'm covered as well even thought I get all of my care at the VA. I am still able to use it if I need or want a "second opinion" from what the VA doc tell me. I'm not sure about how much it would cost if you asked to pay cash, but I suspect that if you find a good pulmonary/sleep doc, and explain your situation (disabled vet) that you could negotiate a fair "cash" price for him to fill out the Sleep Apnea DBQ and write a nexus letter. I had my DBQ filled out based on when I had my sleep study (by the VA), and then wrote: "It is my opinion that it is at least as likely as not that Mr. OEF21B's diagnosed OSA is aggravated by his service-connected PTSD. I also feel that it is at least as likely as not that Mr. OEF21B's PTSD is aggravated by his OSA." He continued the nexus letter with: "Mr. OEF21B is on CPAP, and I believe his PTSD causes him nightmares and sleep deprivation and makes it more difficult for him to take his prescribed continuous positive airway pressure mask. I believe this sleep disruption exacerbates anxiety, and depression and affects mental acuity. I believe his PTSD worsens his daytime excessive somnolenceone because he is not able to be treated as effectively for his obstructive sleep apnea." I filled out the same thing on the DBQ form and he signed that as well... Hope this helps!

I used a private doctor to fill out my DBQ and write a nexus letter for me. I was granted "Service connection for sleep apnea has been established as related to the service-connected disability of posttraumatic stress disorder." My VA psych wouldn't write a nexus letter or DBQ because he said that he didn't believe that OSA was connected with PTSD at all... that's when I went to a private sleep doctor under my own insurance. To answer your question, I think it will be very hard to be granted service connection for OSA secondary to PTSD without a nexus letter or a positive DBQ. Good luck with your claim!

Hi Broncovet - Finally got the BWE (mine have all been white envelopes)... - "Service connection for sleep apnea has been established as related to the service-connected disability of posttraumatic stress disorder." - "We have assigned a 50 percent evaluation for your sleep apnea based on: Requires use of breathing asstance device such as a continuous airway pressure (CPAP) machine." That's all it says. The rest of it just mentiones what is required for a higher evaluation of 100%. I think that using the wording of aggravated instead of caused, was the key for this... My VA Psych said that PTSD doesn't CAUSE sleep apnea, in fact he said there was no known correlation that he was aware of. Good luck!!

Hi Rocket - 1)My VA Psych told me that he didn't believe that there was any connection and that he wouldn't complete a DBQ or write a nexus letter for me. I ended up going to a civilian sleep doctor that was listed on my civilian health insurance. This doctor completed the DBQ and well as a nexus letter for me. 2) I was diagnosed with obstructive sleep apnea. My doctor stated that my OSA was at least as likely as not is aggravated by my service connected PTSD. And that it is at least as likely as not that my PTSD is aggravated by my OSA. I think that key issue here was that he/we never stated that the PTSD CAUSED the OSA, just that it aggravated it. 3) see #1. absolutely NO help from any of my VA docs. 4) Yes. Good luck with your claim! Semper Fi

VES will send you a letter with the name and address of the Dr. The letter will instruct you to call them and verify your C&P. Don't worry about the examiner's credentials. I'm sure that your examiner will have the required credentials, otherwise, the VA / VES would not use them. If you have any questions, I recommend calling the VES... and NOT the doctor. I called VES several times and they always answered their phone and they were very professional. I know it's stressful and your mind is racing with a million things that "could go wrong"... but this process is straight-forward and you just need to be yourself, be 100% honest, and frame your answers with regards to your worst day. You will do fine. Again, VES and the VA would not schedule your C&P with an unqualified examiner. Semper Fi

Hi Broncovet - I haven't received my BBE yet, so I can't post the VA's rational for award yet. Once I get it, I'll post it. I provided my civilian Sleep/Pulminary Dr. with a "sample" Nexus Letter and a Sleep Apnea DBQ with sections VI-Functional Impact, and VII-Remarks filled out with 'suggested' language. After a quick exam, the Dr. agreed to sign the DBQ and Nexus Letter with a few minor changes. I'm pretty sure that the DBQ as well as the Nexus letter were considered fairly highly since both contained a statement linking my OSA with my PTSD... The wording didn't say that my OSA was CAUSED by my PTSD, just that my OSA AGGRAVATED my PTSD; and my PTSD AGGRAVATED my OSA. I think that the aggravated VS caused wording was key, but I'll have to wait and see what the actual award letter says. Semper Fi

Hi Buck! I had my PTSD increase C&P with the VES. My appointment was in Frisco, TX. All of the VES contracted doctors have access to your VA records (I asked). They normally have 72-hrs (working days) to complete thier report and return it to the VA. With regards to what to expect: Be yourself. Be 100% honest. Frame your answers as related to your WORST day/symptoms. Most doctors will start off by asking "How are you doing"... its OK to let them know that you are nervous/anxious/scared/. My VES Psych said that she had been doing VA evaluations for 8 years. Your Psych Evaluator should be very familiar with the VA process. During my PTSD increase C&P, my examiner didn't use a computer. She had a legal pad and just asked me a series of questions. If your examination is an initial PTSD exam, your examiner may use a computer or they may not... Regardless remember to frame your answers as related to your worsd day/symptoms... and be honest! Most Psych's that have been doing these exams can pick up on BS so try to relax and just answer the questions as best as you can. I wrote out some notes to bring with me for my exam and I also had copies of my initial PTSD C&P as well as some of my VA Psych treatment notes. There is nothing wrong with bringing notes with you to your C&P. I had one page of notes that contained all of the details for my stressor event(s)... dates, location, what happend, names of KIA & WIA, etc. Use these notes to help you remember how this event affected you (fear / helplessness / guilt / etc.). I had a second page of notes where I listed all of my symptoms along with 2-3 examples under each symptom... for example: Suicidal Ideations (2-3 examples); Memory Loss (2-3 examples); Obsessive behaviors (2-3 examples); Panic Attacks (2-3 examples); Impaired Impulse (2-3 examples); Depression (2-3 examples); Unprovoked Anger (2-3 examples); Avoidance (2-3 exmples); etc. Main point is to think through how the stressor incident affects your work/home life/relationships with others/your normal daily routine. This will help you with the questions during your PTSD C&P. Good luck and please let us know how your C&P goes! Semper Fi

Thanks everyone! I was a little leary of using the Veterans Evaulation Services (VES), but both of my C&P's (PTSD increase and Sleep Apnea) were schedule within a month and the doctors for each C&P were very familiar with what the VA is looking for with regard to claims. I'm defenitly NOT an expert in getting service connected for Sleep Apnea secondary to PTSD, but I know this has been a hot topic around here. My claim was with the Waco Regional Office and I'll do my best to answer any questions you might have. Semper Fi

Just saw on E-Benefits that my Sleep Apnea claim as secondary to PTSD was granted at 50%. For the Sleep Apnea: - No history of sleep issues while on active duty or in STRs - VA Psych requested sleep study, Sleep Study completed by VA-Outsoursed Hospital, Diag. w/mod. Sleep Apnea and issued a VA CPAP in May 2013. - My private Sleep/Pulminary Doc completed Sleep Apnea DBQ & wrote nexus letter stating "Based on my evaluation of the veteran, it is my opinion that it is at least as likely as not that Mr OEF21B's diagnosed OSA is aggravated by his service connected PTSD. I also feel that it is at least as likely as not that Mr OEF21B's PTSD is aggravated by his OSA." (17 JUL 15) Filed Sleep Apnea claim 28 JUL 15 - Sleep Apnea C&P in AUG 15 with the Veterans Evaluation Services (VES). Brought copy of DBQ and Nexus Letter as well as some of the articles linking PTSD & SA. I thought the C&P went well and the Dr. said that she would add the articles as well as my DBQ & Nexus letter to her final report. IMHO, I believe that my private doc's completion of a DBQ as well as his Nexus letter was key in meeting the requirement for service connection secondary to PTSD. I also believe that providing these along with the articles listed here in various places, and providing all of this to the C&P examiner helped. Semper Fi

I guess this should actually go in the "Good News" section but I wanted to follow up on this original post: Just got the news that my request for increase for PTSD was granted (50% to 70%), and my Sleep Apnea claim as secondary to PTSD was granted at 50%. For the Sleep Apnea: - No history of sleep issues while on active duty or in STRs - VA Psych requested sleep study, Sleep Study completed by VA-Outsoursed Hospital, Diag. w/mod. Sleep Apnea and issued a VA CPAP in May 2013. - My private Sleep/Pulminary Doc completed Sleep Apnea DBQ & wrote nexus letter stating "Based on my evaluation of the veteran, it is my opinion that it is at least as likely as not that Mr OEF21B's diagnosed OSA is aggravated by his service connected PTSD. I also feel that it is at least as likely as not that Mr OEF21B's PTSD is aggravated by his OSA." (17 JUL 15) Filed Sleep Apnea claim 28 JUL 15 - Sleep Apnea C&P in AUG 15 with the Veterans Evaluation Services (VES). Brought copy of DBQ and Nexus Letter as well as some of the articles linking PTSD & SA. I thought the C&P went well and the Dr. said that she would add the articles as well as my DBQ & Nexus letter to her final report. IMHO, I believe that my private doc's completion of a DBQ as well as his Nexus letter was key in meeting the requirement for service connection secondary to PTSD. I also believe that providing these along with the articles listed here in various places, and providing all of this to the C&P examiner helped. Semper Fi

Hi Wjason777, Here's what I just submitted for an increase for my current 50% PTSD rating on the 17th of August 2015. I didn't include copies of the actual notes since the VA should be able to pull them up. I just listed the date and the major symptoms noted in each Dr.'s treatment notes. Hopefully I'll either get an increased rating based on the treatment notes, or will have a PTSD C&P scheduled. E-Benefits is showing "RVSR for opinion exam" so I'll probably get a PTSD C&P date in the mail.... ----------------------------------------------------------------------------- I request an increase rating for my service connected PTSD from 50% to 70% based on increased symptoms as noted in 4.130 Schedule of ratings - mental disorders 9440. My request is based on treatment notes from Dr. xxxxx, Staff Psychologist, and Dr. xxxxxxx, Staff Physician, VA Outpatient Clinic, xxxxxxxxx. Date Treating Doctor Noted Symptom(s) 28 Jan 2013 Dr. xxxx Stress at Work; disturbing dreams 16 Apr 2013 Dr. xxxx Lack of intimacy, lack of connection with daughters Supervisor questioning treatment 17 Jun 2013 Dr. xxxxxx Social Avoidance 09 Oct 2013 Dr. xxxxxx Continued social anxiety and social avoidance 09 Jan 2014 Dr. xxxxxx Patient doing fairly well, current meds helpful 27 Oct 2014 Dr. xxxxxx A lot of social avoidance, occasional problems with irritability, sexual side effects, solitary activities 02 Feb 2015 Dr.xxxxxx Patient doing well with increase in meds, sexual side effects 06 May 2015 Dr. xxxxxx Having problems over last 1-2 months, more sleep disturbance, nightmares, anxiety and hyper- vigilance as well as more withdrawal 16 Jul 2015 Dr. xxxxxxx Some sleep disturbance and low energy, low motivation 07 Aug 2015 Dr. xxxxxx Nightmares, social anxiety, irritability at home adding Gabapentin for anxiety/irritability The VA treatment notes show occupational and social impairment, with deficiencies in most areas such as work and family relations due to impaired impulse control (unprovoked irritability), difficulty in adapting to stressful circumstances including work, or a work like setting; and inability to establish and maintain effective relationships. History of Condition: I started treatment at the xxxxxx VA Outpatient Clinic in 2010. My staff Psychiatrist is Dr. xxxxxx, and my staff psychiatrist is Dr. xxxxxxx. I have completed the PTSD Basics class, the Nightmare group, and attend the weekly OEF/OIF drop-in group. My symptoms have mainly consisted of social anxiety, social avoidance, hyper-vigilance, and sleep/nightmare issues. Dr. xxxxxx has changed my medications numerous times in order to help minimize the sexual side effects of my treatment medications. I started having issues with impaired impulse control(unprovoked irritability) with my family and co-workers around the fall of 2014. Dr. xxxxxx has been treating the unprovoked irritability with various medications since then and recently this month increased my current medication (Duloxetine) from 60mg a day to 120mg a day and added a new medication (Gabapentin, 900 mg a day) to help with anxiety/irritability. The unprovoked irritability has caused occupational and social impairment with my work and family relations. I am having almost daily panic attacks and keep a bottle of Alprazolam with me at all times. My family is afraid to be around me out of fear that I will "blow up". I keep to my self at work and try to minimize all contact with my co-workers in order to avoid any "problems" that could get me fired. Based on the treatment notes and the history of my treatment with the xxxxxxx VA Outpatient Clinic, I submit that I am exhibiting occupational and social impairment, with deficiencies in most areas such as work and family relations due to impaired impulse control (unprovoked irritability), difficulty in adapting to stressful circumstances including work, or a work like setting; and inability to establish and maintain effective relationships. The overall evidence record shows that the severity of my PTSD most closely approximates the criteria for a higher evaluation of 70%.

Does anyone know what "RVSR for opinion exam" mean? Filed for Sleep Apnea to include due to Aggravavation by PTSD (secondary) on 7/28/15. Filed for PTSD (Increase) on 8/17/15. E-benefits showed two separate claims until yesterday afternoon. There was a note under the PTSD increase requesting me to submit additional documents or a DBQ. When I checked E-benefits yesterday afternoon, both claims were combined and the request for additional documents or a DBQ were no longer on the combined claims. The note below the combined claim now says "RVSR for opinion exam". I provided a DBQ form AND a nexus letter from my civilian board certified doctor and my PTSD increase indicated ten (10) VA mental health treatment notes that specifically noted my increased symptoms. I'm guessing that the note means that they are considering scheduling me for a C&P for either Sleep Apnea, or PTSD, or both... but wanted to see if anyone here has seen this same note. Thanks! OEF 21B Sorry - having issues uploading the PDF files... I have the sleep apnea DBQ & Nexus Letter on another thread in the General Questions section. I'll try to upload the files again later.

Added the actual DBQ and Nexus letter from civilian Doc. Any additional feedback for my claim of Sleep Apnea to include as secondary to PTSD? thanks!